Provider Demographics
NPI:1346790425
Name:HANI KHALIL PSYCHIATRIC NURSE PRACTITIONER PC
Entity Type:Organization
Organization Name:HANI KHALIL PSYCHIATRIC NURSE PRACTITIONER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:845-471-2345
Mailing Address - Street 1:52 WENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3843
Mailing Address - Country:US
Mailing Address - Phone:845-471-2345
Mailing Address - Fax:845-471-2223
Practice Address - Street 1:1133 ROUTE 55 STE 11
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5052
Practice Address - Country:US
Practice Address - Phone:845-471-2345
Practice Address - Fax:845-471-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty